Provider Demographics
NPI:1982911145
Name:FAY, BREWSTER W (PHD)
Entity Type:Individual
Prefix:DR
First Name:BREWSTER
Middle Name:W
Last Name:FAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:FAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:500 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2335
Mailing Address - Country:US
Mailing Address - Phone:610-667-6159
Mailing Address - Fax:610-667-6159
Practice Address - Street 1:31 NORTH NARBERTH AVENUE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-348-1472
Practice Address - Fax:610-668-1479
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-002699-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical